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1LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas, USA

2Population Research Center, University of Texas at Austin, Austin, Texas, USA

3College of Natural Sciences, University of Texas at Austin, Austin, Texas, USA

4Department of Sociology, University of Texas at Austin, Austin, Texas, USA

Correspondence to
Dr Abigail R A Aiken, LBJ School of Public Affairs, University of Texas at Austin, Austin, TX 78713, USA; araa2{at}utexas.edu

Abstract

Background In Northern Ireland, abortion is illegal except in very limited circumstances to preserve a woman’s life or to prevent permanent or long-term injury to her physical or mental health. Abortions conducted outside the law are a criminal offence punishable by imprisonment. We assessed the impacts of Northern Ireland’s abortion laws on women’s decision-making and experiences in accessing abortion.

Methods Between April 2017 and February 2018 we interviewed 30 women living in Northern Ireland who had sought abortion by travelling to a clinic in Great Britain or by using online telemedicine to self-manage a medication abortion at home. We interviewed women both before and after a policy change that allowed women from Northern Ireland access to free abortion services in Great Britain. We used a semi-structured in-depth approach and analysed the interviews using grounded theory methodology to identify key themes.

Results Four key findings emerged from our analysis: (1) women experience multiple barriers to travelling for abortion services, even when abortion is provided without charge; (2) self-management is often preferred over travel, but its criminalisation engenders fear and isolation; (3) obstruction of import of abortion medications by Northern Ireland Customs contributes to stress, anxiety, a higher risk of complications, and trial of ineffective or unsafe methods; and (4) lack of clarity surrounding the obligations of healthcare professionals in Northern Ireland causes mistrust of the healthcare system.

Conclusions Northern Ireland’s abortion laws negatively affect the quality and safety of women’s healthcare and can have serious implications for women’s physical and emotional health. Our findings offer new perspectives for the current policy debate over Northern Ireland’s abortion laws and suggest a public health rationale for decriminalising abortion.

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Footnotes

Contributors ARAA designed the research question and the study approach. ARAA, EP, KB and DJ all contributed to the design of data collection instruments, data collection, and data analysis and interpretation. ARAA, EP, KB and DJ all contributed to writing the first draft of the manuscript, and all read and revised subsequent drafts for intellectual content. ARAA, EP, KB and DJ all approved the final draft of the manuscript for submission and accept responsibility for the paper as published.

Funding The study was supported by funding from a Junior Investigator grant from the Society of Family Planning, a grant from the European Society of Contraception and Reproductive Health, and a grant from the HRA Pharma Foundation. The study was also supported in part by infrastructure grant P2CHD042849, awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Society of Family Planning, the European Society of Contraception and Reproductive Health, or the HRA Pharma Foundation.

Competing interests None declared.

Patient consent Not required.

Ethics approval The study received ethical approval from the Institutional Review Board at the University of Texas at Austin.

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